P1.064: Risk Factors for Postoperative Coagulopathy in PICU Patients Following Major Tumor Resections for Neuroblastoma

Background:

Background: Pediatric oncology patients are at a high risk of developing coagulopathy due to their disease and treatment. For those patients who require major surgical resections, coagulopathy can lead to an increased risk of complications. The incidence and risk factors of postoperative coagulopathy in patients with neuroblastoma is poorly characterized. Our study aims to identify risk factors associated with postoperative coagulopathy in patients admitted to the pediatric intensive care unit (PICU) following major tumor resections for neuroblastoma.

Methods:

Methods: Under IRB approval, we collected demographic information, preoperative laboratory data, and intraoperative parameters of 179 PICU patients aged 0-18 years with neuroblastoma who underwent major tumor resection in the chest, abdomen, or pelvis at our institution between January 2019 and December 2023. Patients with a history of coagulopathy were excluded. Postoperative coagulopathy was defined as one or more of the following events: INR > 1.5, PT > 15 seconds, aPTT > 55 seconds, or platelet count < 100 × 10^9/L. Univariable and multivariable logistic analyses were performed to identify independent predictors of postoperative coagulopathy.

Results:

Results: Of the 179 patients, 126 (70.4%) met one or more criteria for postoperative coagulopathy. The median age at surgery was 37 months (IQR: 22-64 months). One hundred thirty-six patients presented with high-risk (82%), 26 (16%) with intermediate-risk, and 3 (2%) with low-risk neuroblastoma. Forty-four patients (26%) had presence of MYCN amplification. Surgeries were performed via thoracoabdominal approach in most patients (77.7%), followed by open thoracic approach (12.3%), laparotomy (8.4%), flank retroperitoneal approach (1.1%), and sacral approach (0.6%).

In univariable analysis, younger age (OR = 0.99 per month, p = 0.013), preoperative international normalized ratio (OR = 1.07 per 0.01 unit increase, p = 0.016), longer surgery duration (OR = 1.05 per 10 min increase, p< 0.001), greater intraoperative blood loss (OR = 1.05 per 10 mL increase, p< 0.001), higher crystalloid volume (p < 0.0001), and receipt of colloids (OR = 5.07, p< 0.001) and RBCs (OR = 3.53, p< 0.001) were significantly associated with increased risk of developing postoperative coagulopathy. Multivariate logistic regression analysis identified younger age (OR = 0.98, p = 0.002), preoperative INR (OR = 1.11, p = 0.002), greater intraoperative blood loss (OR = 1.04, p = 0.009), and receipt of colloids (OR = 3.38, p = 0.004) as independent predictors.

Conclusion:

Conclusion: Postoperative coagulopathy is highly prevalent among pediatric neuroblastoma patients undergoing major tumor resections. We found four independent predictors of postoperative coagulopathy: younger age, preoperative INR approaching the upper limit of normal, greater intraoperative blood loss, and receipt of colloids. These identified risk factors may help clinicians to better anticipate and prepare for potential postoperative coagulopathies in this population.